What is the Future for DBS?

DBS has provided dramatic improvements in quality of life for patients with PD, tremor, dystonia, and other movement and basal ganglia related brain disorders. As the technology is refined we will learn to improve our treatment of “motor (tremor, stiffness, slowness, balance, gait),” as well as “non-motor (mood, cognitive, and behavioral)” symptoms, perhaps in combination with other therapies. Additionally, we will need to improve on our ability to select the best possible candidates and those who have the most favorable risk-benefit ratios.

In the next 5-10 years we will need to become more sensitive to the unrealistic hope of some patients and families. We will also need to better educate them about who is a candidate, and what they can expect and anticipate from a surgical approach to their problems. There will be rechargeable devices in the foreseeable future, as well as devices that will work on a closed-loop circuit, meaning they will automatically turn on when needed (like a cardiac defibrillator).

Finally, we will adapt this technology to be used for other promising therapies such as viral vectors, gene therapies, stem cell therapies, and the instillation of other factors which may aid in the survival of brain cells. Since many of these diseases are neurodegenerative, and many have multiple motor and non-motor manifestations, we can reasonably expect that DBS will be used in combination with other promising therapies and technologies.

Now that DBS is an accepted therapy, we the practitioners will have to accept the responsibility of delivering the highest quality of care to the patients and families who need it the most. It will be important for us to proceed with caution, and realize that just like any choice in life, DBS is not for everyone.